PD: Catheter outflow failure

I recently saw a patient in our peritoneal dialysis clinic who had been ultrafiltering about a liter a day but who was now consistently draining 100ml less than his instilled PD solution volumes despite extended drain times and…

An eye opener!

Call it serendipity or mere coincidence, I recently saw a patient with Prostate cancer treated with an experimental chemotherapy protocol that was sent to our clinic for evaluation of Fanconi syndrome and proteinuric stage 3 chronic kidney disease…

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Drug-induced hyponatremia

When reviewing a consult patient with hyponatremia, the first thing I look at is the medication list to see if the culprit is to be found there. Along with the usual suspects – diuretics, NSAIDs, SSRIs and anti-convulsants,…

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Lupus – persistent low complements

Consider a patient with long-standing SLE who has biopsy proven WHO class IV lupus nephritis, previously treated with cyclophosphamide and steroids, which induced remission. Due to recurrence of proteinuria and desire to remain steroid-free, MMF was commenced with…

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High Maintenance

Many nephrologists will have faced “interesting specialty, shame about the evidence-base” jokes in the past. However, following a profusion of randomised controlled trials in lupus nephritis, we are now entering an era where we can integrate data to…

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Clearance and Kt/V

The complete removal of a substance expressed as volume per unit time is known as clearance. The hemodialysis machine is built to be a urea clearance machine and typical urea clearance rates range from 200-260 ml/min, far more…

What about the Bicarb?

In our dialysis unit, the standard HCO3 bath is 35 mmol/L. While it is adjustable, it is rarely changed but recently we had a patient with a pre-dialysis HCO3 of 12 which got me thinking about what constitutes…

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